Efficacy of osimertinib and the role of sequential liquid biopsy in patients diagnosed with NSCLC harboring EGFR and BRAF mutations at baseline: insights from two case reports

Loc Carlo Bao; Alessia Padovan; Andrea Boscolo Bragadin; Lorenzo Calvetti; Valentina Guarneri; Laura Bonanno; Stefano Indraccolo

doi:10.3389/fonc.2024.1363069

Efficacy of osimertinib and the role of sequential liquid biopsy in patients diagnosed with NSCLC harboring EGFR and BRAF mutations at baseline: insights from two case reports

Front Oncol. 2024 Mar 11:14:1363069. doi: 10.3389/fonc.2024.1363069. eCollection 2024.

Authors

Loc Carlo Bao^#¹, Alessia Padovan^#², Andrea Boscolo Bragadin², Lorenzo Calvetti³, Valentina Guarneri^{1

4}, Laura Bonanno^#^{1

4}, Stefano Indraccolo^#^{1

2}

Affiliations

¹ Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
² Basic and Translational Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
³ Department of Oncology, Azienda ULSS 8 Berica, San Bortolo General Hospital, Vicenza, Italy.
⁴ Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.

^# Contributed equally.

Abstract

Epidermal Growth Factor Receptor (EGFR) and B-Raf (BRAF) mutations are two of the most important drivers identified in non-small-cell lung cancer (NSCLC). This report highlights two cases of patients diagnosed with metastatic NSCLC bearing concurrent EGFR and BRAF mutations at baseline and treated with osimertinib as first-line treatment. Molecular profiling was conducted in the tissue and plasma at the time of initial diagnosis, and subsequent repeated liquid biopsy examinations were planned after 10 days, 28 days, and at the time of radiological progression in the frame of the prospective translational study REM. These cases suggest that osimertinib may maintain its therapeutic effectiveness even in patients presenting with a baseline BRAF co-mutation. Notably, radiological responses align with liquid biopsy observations: in both instances, follow-up liquid biopsies indicate the clearance of EGFR-mutated circulating tumor DNA (ctDNA).

Keywords: BRAF; EGFR; NGS; NSCLC; co-mutation; liquid biopsy; osimertinib.

Publication types

Case Reports

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study received funding from Ricerca Corrente - Ministero della Salute and Astra Zeneca. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.